Jaeyeop Jeong; Sang Pyo Kim; Eunyoung Jung; Soon-Ok Choi

doi:10.13029/jkaps.2016.22.2.23

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Jeong, Kim, Jung, and Choi: The Usefulness of Calretinin Immunohistochemistry for Rectal Suction Biopsy to Diagnose Hirschsprung’s Disease

Original Article

Journal of the Korean Association of Pediatric Surgeons 2016; 22(2): 23-28.

Published online: 22 December 2016

DOI: https://doi.org/10.13029/jkaps.2016.22.2.23

The Usefulness of Calretinin Immunohistochemistry for Rectal Suction Biopsy to Diagnose Hirschsprung’s Disease

Jaeyeop Jeong¹, Sang Pyo Kim², Eunyoung Jung¹, Soon-Ok Choi¹

¹Department of Pediatric Surgery, Donsgan Medical Center, Keimyung University School of Medicine, Daegu, Korea.

²Department of Pathology, Donsgan Medical Center, Keimyung University School of Medicine, Daegu, Korea.

Correspondence: Eunyoung Jung, Department of Pediatric Surgery, Dongsan Medical Center, Keimyung University School of Medicine, 56 Dalseong-ro, Jung-gu, Daegu 41931, Korea. Tel: +82-53-250-8091, Fax: +82-53-250-7322, eyjung@dsmc.or.kr

Received 1 June 2016 Revised 11 July 2016 Accepted 21 July 2016

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Hirschsprung’s disease (HD) is a congenital intestinal disorder with absence of ganglion cells in the intestinal muscle and submucosa. Diagnosis is based on histopathological study such as H&E, and acetylcholinesterase (AchE) immunohistochemistry. Calretinin immunohistochemistry was introduced as a new diagnostic method against limitations of other staining. The aim of this study is to investigate the usefulness of calretinin immunohistochemistry for the diagnosis of HD compared to H&E and AchE.

Methods

Ten patients with HD and 22 non-HD patients were included in the study. H&E staining, AchE and calretinin immunohistochemistry were performed in all 32 patients. All slides were evaluated by same single pathologist and the diagnostic value was calculated for each H&E stain, AchE immunohistochemical staining, and calretinin immunohistochemical staining.

Results

Calretinin method had sensitivity of 100% and specificity of 100% for diagnosis of HD. Its diagnostic accuracy was 100%. AchE staining showed 100% of specificity and 80% of sensitivity. Diagnostic accuracy of H&E staining was 56.3%.

Conclusion

We concluded that calretinin immunohistochemistry is a very useful and valuable method to diagnosis HD patient.

Keywords: Hirschsprung disease, Calbindin 2, Acetylcholinesterase, Hematoxylin, Diagnosis

Figures and Tables

Fig. 1

Hirschsprung’s disease (HD) case shows diffuse proliferation of acetylcholinesterase (AchE) fibers (arrows) in lamina propria, muscularis mucosa, and submucosa (A), but complete absence of calretinin immunoreactive fibers (C). Non-HD case reveals many thin calretinin immunoreactive fibers (arrows; D), but no proliferation of AchE fibers (B). (A, B) AchE stain, ×100. (C, D) Calretinin stain, ×100.

Fig. 2

Hirschsprung’s disease case shows equivocal acetylcholinesterase (AchE) findings which have mild proliferation of AchE fibers in submucosa (A, B; AchE stain, ×100), but complete absence of calretinin immunoreactive fibers was observed (C, D; calretinin stain, ×100). This case is difficult to differentiate diagnosis for normal variation.

Table 1

Patient Profile

Table 2

Results of Calretinin Immunohistochemical Staining

Sensitivity 100%, specificity 100%, positive predictive value 100%, negative predictive value 100%, accuracy 100%, p<0.001.

Table 3

Cases of Repeated Biopsy

Table 4

Results of Acetylcholinesterase (AchE) Immunohistochemical Staining

Sensitivity 80%, specificity 100%, p<0.001.

Table 5

Results of H&E Staining

p=0.035.

Notes

The content of this article was presented at the 30th Annual Meeting of the Korean Association of Pediatric Surgeons, Busan, June 2014.

^{CONFLICTS OF INTEREST} No potential conflict of interest relevant to this article was reported.

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